New WHO guidelines on management of physical health conditions in adults with severe mental disorders

The World Health Organization (WHO) has published new “Guidelines on management of physical health conditions in adults with severe mental disorders”.

Severe mental disorders have been defined as a group of conditions that include moderate to severe depression, bipolar disorder, and schizophrenia and other psychotic disorders.

While unnatural causes of death such as accidents, homicides or suicides are higher in this group of patients than the general population, most deaths are due to physical disease conditions such as diabetes, heart disease, TB, HIV/AIDS, hepatitis B and C. These guidelines intend to provide evidence-based, up-to-date recommendations to practitioners on how to recognize and manage comorbid physical and mental health condition including risk factors such as tobacco, overweight and obesity, .

Some key recommendations include:

Tobacco cessation

·         In people with severe mental disorders, combined pharmacological and non-pharmacological interventions and/or a directive and supportive behavioural intervention programme may be considered and should be tailored to the needs of the population

Weight management

·         Behavioural “tailored” lifestyle (healthy diet, physical activity) interventions should be considered in all people with severe mental disorders who are overweight or obese or at risk of becoming overweight or obese.

·         In this patient group, where lifestyle interventions and/or switching psychotropic medication do not appear successful, adjunctive metformin may be considered under close clinical supervision and monitoring.

Substance use disorders

·         For people with severe mental disorders and comorbid substance use disorders (drug and/or alcohol), interventions should be considered in accordance with the WHO Mental Health Gap Action Programme (mhGAP) guidelines.

·         Non-pharmacological interventions (e.g. motivational interviewing) may be considered and tailored to the needs of the people.

Cardiovascular disease and cardiovascular risk

·         Behavioral lifestyle (healthy diet, physical activity) interventions and/or collaborative care i.e. a multi-professional approach to patient care with a structured management plan, scheduled patient follow-up, and enhanced inter-professional communication is recommended  for cardiovascular disease management.

·         For people with severe mental disorders and cardiovascular risk factors, behavioural “tailored” lifestyle (healthy diet, physical activity) interventions may be considered. These interventions should be appropriate and tailored to the needs of this population.

Diabetes mellitus

·         Behavioral “tailored” lifestyle interventions should be considered for all people with severe mental disorders and diabetes mellitus.

·         In people with depression and comorbid diabetes mellitus, cognitive behaviour therapy for treatment of depression may be considered.

HIV/AIDS

·         For people with severe mental disorders and HIV/ AIDS, antiretroviral drugs should be considered in accordance with the WHO Updated recommendations on first-line and second-line antiretroviral regimens.

·         Additional psychosocial support for treatment adherence should be provided in accordance with the WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection.

Other infectious diseases (TB, Hepatitis B/C)

·         For people with severe mental disorders and TB, non-pharmacological (social, psychological) and pharmacological management should be considered in accordance with the WHO guidelines for the treatment of drug-susceptible TB and patient care and the WHO treatment guidelines for drug-resistant TB.

·         For people with severe mental disorders and hepatitis B, treatment should be considered in accordance with the WHO guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection.

·         For people with severe mental disorders and hepatitis C, treatment should be considered in accordance with the WHO guidelines for the screening care and treatment of persons with chronic hepatitis C infection.

(Source: Guidelines for the management of physical health conditions in adults with severe mental disorders. Geneva: World Health Organization; 2018)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA